2016 National Training Program

1. 2016 National Training Program Module 0 Medicare―Getting Started

2. What Is Medicare? • Health insurance for people • 65 and older • Under 65 with certain disabilities • Amyotrophic Lateral Sclerosis • Any age with End-Stage Renal Disease NOTE: To get Part A and/or Part B, you must be a U.S. citizen or lawfully present in the United States. May 2016 Medicare Getting Started 2

3. Who Runs Medicare? • Centers for Medicare & Medicaid Services (CMS) • Administers the program • Social Security Administration (SSA) • Enrolls most individuals • Railroad Retirement Board (RRB) enrolls railroad retirees May 2016 Medicare Getting Started 3

4. The 4 Parts of Medicare May 2016 Medicare Getting Started 4

5. Your Medicare Coverage Choices Original Medicare or Medicare Advantage Plan Part A Hospital Insurance Part B Medical Insurance Part C Combines Part A and Part B May include, or you may be able to add You can add Part D Prescription Drug Coverage (Most Part C plans cover prescription drugs. You may be able to add drug coverage to some plan types if not already included.) Part D Prescription Drug Coverage Medicare Supplement Insurance (Medigap) Policy May 2016 Medicare Getting Started 5

6. Automatic Enrollment—Part A and Part B • Automatic enrollment for those receiving • Social Security benefits • Railroad Retirement Board benefits • Initial Enrollment Package • Mailed 3 months before • 65 or • 25th month of disability benefits • Includes your Medicare card May 2016 Medicare Getting Started 6

7. Medicare Card • Keep it and accept Medicare Part A and Part B • Return it to refuse Part B • Follow instructions on back of card Front Back May 2016 Medicare Getting Started 7

8. When Enrolling Isn’t Automatic • If you’re not automatically enrolled • You need to enroll with Social Security • Visit SSA.gov, or • Call 1-800-772-1213, or • Visit your local office • If retired from the Railroad, enroll with the Railroad Retirement Board (RRB) • Call your local RRB office or 1‑877‑772‑5772 • Apply 3 months before you turn 65 • Don’t have to be retired to get Medicare May 2016 Medicare Getting Started 8

9. When to Enroll in Medicare • You can first enroll during your Initial Enrollment Period (IEP), which lasts 7 months • Can enroll in premium-free Part A anytime after IEP begins • Can only enroll in Part B (and premium Part A) during IEP and other limited times • May have a lifetime penalty if you don't enroll during IEP May 2016 Medicare Getting Started 9

10. More About Enrolling During Your Initial Enrollment Period (IEP) • Must pay a monthly premium for coverage • Your coverage starts based on when you enroll: • Enroll before the month you turn 65, your coverage starts the month you turn 65 • Enroll the month you turn 65, your coverage starts the next month • Enroll the last 3 months of your IEP, your coverage won’t start for 2 to 3 months NOTE: If you're eligible for premium free Part A, you can enroll in Part A any time after your IEP starts May 2016 Medicare Getting Started 10

11. General Enrollment Period (GEP) • For people who didn’t sign up for Part B (or premium Part A) during their Initial Enrollment Period • January 1–March 31 annually • Coverage starts July 1 • May have to pay a penalty • 10% for twice the number of years you didn’t have Part A • 10% for each full 12 months eligible, but not enrolled in Part B for as long as you have Part B May 2016 Medicare Getting Started 11

12. Premium Part A and Part B Special Enrollment Period (SEP) • Most people don't qualify for an SEP • Must have employer group health plan (EGHP) coverage based on active, current employment of you or your spouse • Can enroll • Anytime still covered by EGHP, or • Within 8 months of the loss of coverage or current employment, whichever happens first • Retiree and COBRA coverage aren’t considered active employment May 2016 Medicare Getting Started 12

13. Check Your Knowledge―Question 1 Why is your Medicare Initial Enrollment Period important? • Missed enrollment deadlines could result in penalties • It’s your first opportunity to enroll in Medicare • When you enroll impacts when your coverage begins • All of the above May 2016 Medicare Getting Started 13

14. Decision: How Do I Want to Get My Medicare Coverage? Maybe? • Original Medicare or Medicare Advantage? • Should I take Part A and Part B? When? • Do I need a Medigap policy? • What about Part D? • What do I need to do if I’m not retiring at 65? May 2016 Medicare Getting Started 14

15. Original Medicare Part A—Hospital Insurance Coverage • Part A–Hospital Insurance helps cover • Inpatient hospital care • Inpatient skilled nursing facility (SNF) care • Blood (inpatient) • Certain inpatient non-religious, nonmedical health care in approved religious nonmedical institutions (RNHCIs) • Home health care • Hospice care May 2016 Medicare Getting Started 15

16. Paying for Medicare Part A • Most people don’t pay a premium for Part A • If you paid Federal Insurance Contributions Act (FICA) taxes at least 10 years • If you paid FICA less than 10 years, you can pay a premium to get Part A • May have a penalty if you don’t enroll when first eligible for premium Part A • Your monthly premium may go up 10% • You'll have to pay the higher premium for twice the number of years you could’ve had Part A, but didn't sign up May 2016 Medicare Getting Started 16

17. Part A—What You Pay in Original Medicare May 2016 17 Medicare Getting Started

18. Benefit Periods • Measures use of inpatient hospital and skilled nursing facility (SNF) services • Begins the day you first receive inpatient care • In hospital or SNF • Ends when not in hospital/SNF 60 days in a row • Pay Part A deductible for each benefit period • No limit to number of benefit periods you can have May 2016 Medicare Getting Started 18

19. Decision: Do I Need to Sign up for Part A? • Consider • It’s free for most people • You can pay for it if your work history isn’t sufficient • There may be a penalty if you delay • If you/your spouse is actively working and covered by employer plan • Talk to your benefits administrator • Stop contributions to Health Savings Account 6 months prior to enrollment • Private insurance doesn’t have to pay primary if you aren’t enrolled May 2016 Medicare Getting Started 19

20. Original Medicare Part B—Medical Insurance Coverage • Part B—Medical Insurance helps cover • Doctors’ services • Outpatient medical and surgical services, supplies • Clinical lab tests • Durable medical equipment • Diabetic testing supplies • Preventive services May 2016 Medicare Getting Started 20

21. What You Pay—Part B Premium • Most people will continue to pay $104.90 per month due to no 2016 Social Security cost-of-living adjustment (if their Part B premium was deducted from their December 2015 and January 2016 Social Security or Railroad Retirement benefits [they are held harmless]) • You may pay a higher premium if you have a Part B late enrollment penalty • There’s a new standard premium some people will need to pay in 2016 (see next page) May 2016 Medicare Getting Started 21

22. What You Pay—2016 Standard Part B Premium • Those who’ll pay the 2016 standard premium ($121.80 or higher) include people in any of these 5 groups: • Enroll in Part B for the first time in 2016 • Don’t get Social Security/Railroad Retirement benefits • Are directly billed for their Part B Premiums • Have both Medicare and Medicaid, and Medicaid pays their premiums • Have a modified adjusted gross income, as reported on their IRS tax return from 2 years ago, is above a certain amount (Income-Related Monthly Adjustment Amount [IRMAA]) May 2016 Medicare Getting Started 22

23. Monthly Part B Standard Premium—Income-Related Medicare Adjustment Amount for 2016 Chart is based on your yearly income in 2014 (for what you pay in 2016) was NOTE: You may pay more if you have a Part B late enrollment penalty. May 2016 Medicare Getting Started 23

24. Part B—What You Pay in Original Medicare May 2016 Medicare Getting Started 24

25. Decision: Should I Keep/Sign up for Part B? • Consider • Most people pay a monthly premium • Usually deducted from Social Security/Railroad Retirement benefits • Amount depends on income • It may supplement employer coverage • Contact your benefits administrator to understand the impact to your employer plan May 2016 Medicare Getting Started 25

26. When You Must Have Part B • If you want to buy a Medigap policy • If you want to join a Medicare Advantage Plan • You're eligible for TFL or CHAMPVA • Your employer coverage requires you have it (less than 20 employees) • Talk to your employer’s or union benefits administrator • Veterans Affairs (VA) benefits are separate from Medicare • You pay a penalty if you sign up late or if you don’t sign up during your Initial Enrollment Period May 2016 Medicare Getting Started 26

27. Part B and Active Employment • If you don’t have coverage from active employment • Delaying Part B may mean • Higher premiums • Paying for your health care out-of-pocket • Waiting until next General Enrollment Period to enroll (January 1–March 31) • With coverage not starting until July 1 • If you do have coverage through active employment • You may want to delay Part B • No penalty if you enroll while you have coverage or within 8 months of losing coverage May 2016 Medicare Getting Started 27

28. Check Your Knowledge―Question 2 Medicare Part A helps pay for all of the following when medically necessary and requirements are met, EXCEPT for? Diabetic testing supplies An inpatient hospital stay An inpatient skilled nursing facility stay Hospice care May 2016 Medicare Getting Started 28

29. Check Your Knowledge―Question 3 For Medicare Part B, in most cases, you pay _______. A monthly premium A yearly deductible 20% coinsurance for most covered services All of the above May 2016 Medicare Getting Started 29

30. What’s a Medigap Policy? • Medicare Supplement Insurance (Medigap) Policies • Sold by private insurance companies • Fills gaps in Original Medicare coverage • Deductibles, coinsurance, copayments • All plans with same letter • Have same coverage • Costs are different • Except Minnesota, Massachusetts, and Wisconsin May 2016 Medicare Getting Started 30

31. Medigap Plan Types *Plan F is also offered as a high-deductible plan by some insurance companies in some states. If you choose this option, this means you must pay for Medicare-covered costs (coinsurance, copayments, deductibles) up to the deductible amount of $2,180 in 2016 before your policy pays anything. **For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible ($166 in 2016), the Medigap plan pays 100% of covered services for the rest of the calendar year. ***Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission. May 2016 Medicare Supplement Insurance (Medigap) Policies 31

32. Decision: Do I Need a Medigap Policy? • Consider • It only works with Original Medicare • Do you have other supplemental coverage? • If so, you might not need Medigap • Can you afford Medicare deductibles and copayments? • What does the monthly Medigap premium cost? May 2016 Medicare Getting Started 32

33. How Do I Find the Right Medigap Policy for Me? • Compare plans by computer or phone • Visit Medicare.gov/find-a-plan • Use the Medigap comparison tool • Call 1-800-MEDICARE (1-800-633-4227). • TTY users should call 1-877-486-2048. • Call your State Health Insurance Assistance Program (SHIP) • Only a few states extend protections to the disabled population • Check with your State Department of Insurance May 2016 Medicare Getting Started 33

34. When Is the Best Time to Buy a Medigap Policy? • Consider • Your Medigap Open Enrollment Period (OEP) begins the month you're 65 or older AND enrolled in Part B • Lasts 6 months minimum, may be longer in your state • You have protections—companies MUST sell you a plan if in your OEP • You can also buy a Medigap policy whenever a company agrees to sell you one • If later, there may be restrictions May 2016 Medicare Getting Started 34

35. To Buy a Medigap Policy, Follow These Steps • Decide which Medigap Plan A–N has the benefits you need • Find out which insurance companies sell Medigap policies in your state • Call your State Health Insurance Assistance Program (SHIP), your State Insurance Department, or visit Medicare.gov • Check if your state extends protections for those with a disability • Call the insurance companies and shop around for the best policy at a price you can afford • Once you choose the insurance company and the Medigap policy, apply for the policy May 2016 Medicare Getting Started 35

36. Check Your Knowledge—Question 4 Medigap (Medicare Supplement Insurance) policies may help pay for prescription drug copayments. True False May 2016 Medicare Getting Started 36

37. Part D—Medicare Prescription Drug Coverage • Available for all people with Medicare • Provided through • Medicare Prescription Drug Plans (PDPs) • Medicare Advantage Prescription Drug Plans (MA-PDs) • Some other Medicare health plans May 2016 Medicare Getting Started 37

38. How Medicare Part D Works • It’s optional • You can choose a plan and join • May pay a penalty to join later • Plans have formularies • Lists of covered drugs • Must include range of drugs in each category • You pay the plan a monthly premium • You pay deductibles and copayments • There’s Extra Help to pay Part D costs • If you have limited income and resources May 2016 Medicare Getting Started 38

39. Who can join Part D? • You must • Have Medicare Part A and/or Part B to join a Medicare Prescription Drug Plan • Have Medicare Part A and Part B to join a Medicare Advantage Plan with drug coverage • Have Medicare Part A and Part B or only Part B to join a Medicare cost plan with Part D coverage • Live in the plan’s service area • Not be incarcerated • Not be unlawfully present in the U.S. • Not live outside the U.S. • You must join a plan to get drug coverage May 2016 Medicare Getting Started 39

40. When Can I Enroll in a Part D Plan? • During your 7-month Initial Enrollment Period • During the yearly Open Enrollment Period • October 15–December 7 each year • Coverage begins January 1 • May be able to join at other times • Medicare Advantage Disenrollment Period • Special Enrollment Period • For example, anytime you get Extra Help May 2016 Medicare Getting Started 40

41. Choosing a Part D Plan • Compare plans by computer or phone • Use the Medicare Plan Finder at Medicare.gov/find-a-plan • Call 1-800-MEDICARE (1-800-633-4227). • TTY users should call 1-877-486-2048. • Contact your State Health Insurance Assistance Program (SHIP) for help comparing plans • To join a Part D Plan • Enroll at Medicare.gov • Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. • Enroll on the plan’s website or call the plan • Complete a paper enrollment form May 2016 Medicare Getting Started 41

42. Decision: Should I Enroll in a Part D Plan? • Consider • Do you have creditable drug coverage? • Coverage as good as Medicare’s • For example, through an employer plan • No penalty if you have creditable drug coverage and delay enrolling in a Medicare drug plan • Will that coverage end when you retire? • How much do your current drugs cost? • What do the premiums cost for Part D plans? • Without creditable coverage • Later enrollment may mean you pay a penalty • If a period of 63 or more days in a row lapse May 2016 Medicare Getting Started 42

43. Check Your Knowledge—Question 5 In most cases, you can get Medicare prescription drug coverage through_____. Part A and Part B Part B and Part C Part C and Part D All of the above May 2016 Medicare Getting Started 43

44. Check Your Knowledge—Question 6 It’s July. You enrolled in Medicare last year but didn’t enroll in a Medicare drug plan. Generally, when is your next chance to enroll in Part D? Open Enrollment Period Initial Enrollment Period Your next birthday 12 months after your initial enrollment May 2016 Medicare Getting Started 44

45. Part C—Medicare Advantage • Health plan options approved by Medicare • Another way to get Medicare coverage • Still part of the Medicare program • Run by private companies • Medicare pays the plan an amount • For each member’s care • May have to use network doctors or hospitals • Types of plans available may vary May 2016 Medicare Getting Started 45

46. How Medicare Advantage (MA) Plans Work • If you join an MA Plan you • Are still in Medicare with all rights and protections • Still get those services covered by Part A and Part B • But the MA Plan covers those services instead • May choose a plan that includes prescription drug coverage • May have different benefits and cost-sharing • May choose a plan that includes extra benefits • Such as vision or dental offered at the plan’s expense (not covered by Medicare) May 2016 Medicare Getting Started 46

47. When and How Can I Enroll in a Medicare Advantage Plan? • Generally during your Initial Enrollment Period • During the yearly Open Enrollment Period • October 15–December 7 each year • Coverage begins January 1 • May be able to join at other times • Special Enrollment Period • Contact the plan to join • Call their telephone number • Visit their website • Use the Medicare Plan Finder at Medicare.gov May 2016 Medicare Getting Started 47

48. Decision: Should I Join a Medicare Advantage Plan? • Consider • You must have Part A and Part B to join • Most offer comprehensive coverage • Including Part D drug coverage • Some plans may require you to use a network • You may need a referral to see a specialist • You must pay the Part B and the monthly plan premium • You can only join/leave plan during certain periods • It doesn’t work with Medigap policies • It’s NOT available to MOST people with End-Stage Renal Disease (ESRD) May 2016 Medicare Getting Started 48

49. How Are Medigap Policies and Medicare Advantage Plans Different? Medicare Getting Started 49 May 2016

50. Check Your Knowledge―Question 7 Medicare Advantage Plans __________. Help pay for gaps in Original Medicare Cover less services than Original Medicare Are private plans approved by each state Must cover all Medicare Part A and Part B services May 2016 Medicare Getting Started 50